Nipple Notes

Since some of you have been asking, here's what I know about the nipple-sparing mastectomy. It is a fairly new procedure in the U.S. and is gaining popularity. The accepted view is that since the nipple and areola are connected to the duct system they need to be removed since they could be cancerous. Also, when nipples are left on after mastectomy, there is a high rate of tissue death due to inadequate blood flow. During the procedure, the incision is made right under or right over the areola, the breast tissue is removed and the skin (including the nipple & areola) are inverted and scraped to ensure all breast tissue is removed. The blood vessels need to be reestablished to keep the skin alive and this is helped by having the chest muscle pushed up to the skin with the expander. None of the other doctors I visited before Dr. Wallace would offer this procedure for me. Either it was not a procedure they were comfortable with or they said the risk of leaving cancer behind in the nipple was too great. Dr. Wallace has been performing nipple-sparing mastectomies for 2 years and has one of the highest success rates in the world. Is there a chance that the remaining nipple will be cancerous. Yes - about 1 percent. And if it is cancerous, then the solution is to remove it. So, on the rare chance that there is cancer after my mastectomy, I will just have the nipple and areola removed and proceed with the tattoo/reconstruction options I've written about before. There is also a 15 percent chance that not all the nipple/areola tissue will survive. In that case, Dr. Wallace has said it is better to have some of the tissue because she can use it to reconstruct a more real looking nipple area during my cosmetic reconstruction. So I really see no downside to the nipple-sparing procedure. If I can wake up from surgery and look whole I really think it will help my recovery. And if the tissue doesn't survive, or cancer remains I'll deal with it then. As for now, I'm excited to be able to have this option. In one post I've managed to mention nipples 11 times - I think that's a record!